On April 16, President Barack Obama enthusiastically signed the $214 billion bill known as H.R. 2 Medicare Access and CHIP Reauthorization Act of 2105, or MACRA, repealing the Sustainable Growth Rate (SGR) formula implemented in 1997. 

In doing so, he blocked a 21 percent cut in Medicare payments set to take effect this month. Since 2003, Congress postponed the SGR's called-for cut in physician payments 17 times by passing legislation commonly referred to as a "doc fix." The most recent fix expired on March 31.

Republican House Speaker John Boehner and Democratic Leader Nancy Pelosi negotiated the bill, which the House approved in March by a vote of 402-12 and the Senate approved on April 14 by a vote of 92-8. 

Under the bill, fee-for-service payment rates will increase 0.5 percent annually through 2019; after that, a pay-for-performance program called the Merit-Based Incentive Payment System will take effect. The bill also extends the Children's Health Insurance Program for two additional years. 

Paul Spitalnic, chief actuary for the CMS, said in a report that the annual increases won't keep pace with growth in physicians' costs and noted that funding for the pay-for-performance programs would run out after 2024, according to Medscape. In general, physician organizations such as the American Medical Association and the American Academy of Family Physicians indicated that the bill was less than ideal but was far better than a 21 percent cut in payments—and it would allow physicians to continue treating Medicare beneficiaries.

CMS processed "a small volume" of claims at the lower level before the bill was signed but said those payments would be reprocessed and providers would receive their full fees. 

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